Documente Academic
Documente Profesional
Documente Cultură
Fecha:
ENTREVISTA INFANTIL
Madre:
Padre:
Representante:
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Embarazo:
Parto:
NORMAL: ____________ A TERMINO: __________ INDUCIDO: ___________ PREMATURO: __________
CESAREA: ________ POR QUE?: _____________________________________________________________
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Complicaciones:
RUPTURA PRECOZ DE MEMBRANA: ___________________ TRAUMATISMOS: __________________
CIRCULAR DE CORDN: ___________________________FRCEPS: _______________________________
Desarrollo Evolutivo:
ALIMENTACIN PRIMER AO DE VIDA:____________________________________________________
EDAD DEL DESTETE:_____________________ LEVANTO LA CABEZA:______________________
CAMIN:___________ SE SENT:___________GATE:____________ SE PAR:_____________________
Enfermedades Significativas:
SARAMPIN:_____ RUBOLA:_______ TOS FERINA:______ PAPERAS:______ LECHINA:______
MENINGITIS:_________ ENCEFALITIS:________ CONVULSIONES:_______ EPILEPSIA:________
OTITIS CRNICA:______________ T.C.E. TRAUMATISMO CRANEOENCEFLICO:____________
CARDIOPATIAS:________ DOLORES DE CABEZA PERIODICOS:________ DESMAYOS:_____________
Exmenes:
E.E.G.(FECHA Y RESULTADOS): _____________________________________________________________
RADIOGRAFIAS:___________________________________________________________________________
OTROS: ___________________________________________________________________________________
ACCIDENTES: ____________________________________________________________________________
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CONTROL PEDITRICO
SI________ NO________
VI. Hbitos
SUEO:
ALIMENTACIN:__________________________________________________________________________
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ASEO PERSONAL: ________________________________________________________________________
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IX. Escolaridad
RELACIONES INTERPERSONALES DE(L) (LA) NI@ DENTRO DEL GRUPO FAMILIAR CON PAREJA
PARENTAL: ______________________________________________________________________________
HERMANOS: ______________________________________________________________________________
OTROS FAMILIARES: ______________________________________________________________________
RELACIONES INTERPERSONALES DE(L) (LA) NI@ FUERA DEL GRUPO FAMILIAR (COMPAEROS
Y OTROS) _________________________________________________________________________________
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XII. Genograma
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XVII. Observaciones
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